POS0159 SEX-RELATED DISPARITIES IN HEALTHCARE UTILIZATION IN PATIENTS WITH INFLAMMATORY ARTHRITIS: A POPULATION-BASED STUDY
Authors: S. Tarannum, J. Widdifield, F. Wu, S. Johnson, P. Rochon, L. Eder
Journal: Annals of the Rheumatic Diseases (2022)

Background Delayed diagnosis of inflammatory arthritis (IA) such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) is associated with joint damage and disability. So regular timely assessment by both family physicians and specialists is necessary for favorable disease outcomes. Sex (biology) and gender (socio-cultural) related factors influence clinical patterns of IA, patient behavior and their interaction with care providers. This influence could be reflected in patterns of healthcare utilization. Objectives To compare patterns of musculoskeletal (MSK)-related healthcare utilization before and after diagnosis between male and female patients with IA in Ontario, Canada. Methods We assembled 3 inception cohorts of adult RA, AS and PsA patients diagnosed between April 2010 and March 2017 using Ontario health administrative data. MSK-related healthcare utilization patterns in terms of visits to physicians, MSK imaging and laboratory tests were assessed yearly for 3 years before and after the diagnosis date, and compared between male and female patients. Among individuals ≥ 66 years, prescriptions for rheumatic drugs (NSAIDs, corticosteroids, csDMARDs, advanced therapy (bDMARDs and tsDMARDs)) and opioids were ascertained. Regression models were used to compare healthcare utilization indicators between males and females after adjusting for demographics and comorbidities. Results A total of 41,277 patients with RA (69% females), 8,150 patients with AS (51% females) and 6,446 patients with PsA (54% female) were analyzed. Male patients were significantly older than female patients only in the RA cohort (mean age M 60.4 y, F 57.1 y). Multimorbidity, depression and osteoporosis were more common in female patients and cardiovascular disease in male patients across the 3 cohorts. Similar trends of sex-related differences were observed in all three cohorts. Female patients were more likely to visit rheumatologists and family physicians than male patients especially in earlier pre-diagnosis periods (Figure 1). Male patients were more likely to visit emergency department immediately before diagnosis. A similar female predominance was observed in imaging modalities of X-rays and ultrasounds (adjusted ORs for F:M 1.15 - 1.2 for X-rays and 1.07 -1.44 for ultrasounds), and laboratory tests before diagnosis (adjusted ORs for F:M 1.10 to 2.17) across the three cohorts. Overall DMARD prescription patterns in older male and female patients were similar across the three cohorts except more csDMARD prescriptions in female AS patients (Table 1). Female RA patients were more likely to use NSAIDs and opioids. Table 1. Odds ratios for prescription patterns in inflammatory arthritis for older female to male patients after diagnosis Medication Class Adjusted Odds Ratio (95% Confidence Interval) Rheumatoid Arthritis Ankylosing Spondylitis Psoriatic Arthritis csDMARD Yr 1 1.00 (0.92, 1.09) 1.82 (1.38, 2.41 ) 1.05 (0.81, 1.37) Yr 2 1.00 (0.92, 1.08) 1.66 (1.24, 2.22 ) 0.94 (0.73, 1.20) Yr 3 1.05 (0.97, 1.14) 1.51 (1.12, 2.04 ) 0.85 (0.66, 1.09) Advanced therapy Yr 1 0.99 (0.78, 1.25) 0.79 (0.49, 1.25) 0.75 (0.47, 1.19) Yr 2 1.17 (0.99, 1.39) 0.80 (0.53, 1.23) 0.91 (0.61, 1.37) Yr 3 1.23 (1.05, 1.45 ) 1.04 (0.67, 1.61) 0.88 (0.6, 1.30) NSAID Yr 1 1.14 (1.04, 1.25 ) 1.22 (0.91, 1.63) 0.94 (0.71, 1.24) Yr 2 1.1 (0.99, 1.22) 1.04 (0.77, 1.43) 0.98 (0.73, 1.32) Yr 3 1.16 (1.04, 1.30 ) 1.35 (0.96, 1.89) 1.02 (0.73, 1.41) Opioid Yr 1 1.39 (1.22, 1.58 ) 1.23 (0.85, 1.78) 1.32 (0.87, 1.98) Yr 2 1.51 (1.32, 1.72 ) 1.22 (0.85, 1.76) 1.14 (0.75, 1.75) Yr 3 1.46 (1.27, 1.68 ) 1.42 (0.96, 2.09) 1.45 (0.95, 2.23) Bolded results are statistically significant (p &lt; 0.05) . Odds ratios for female to male patients adjusted for age, residence, income quintiles, comorbidities and access to rheumatologists Conclusion Female patients with IA have higher MSK-related healthcare utilization which may indicate biological differences in disease course or sociocultural differences in healthcare seeking behavior between male and female patients. References N/A Acknowledgements Dr. Sanjana Tarannum received funds from the Enid Walker Graduate Student Award for Research in Women’s Health for this study. Dr. Widdifield receives support from the Arthritis Society Stars Career Development Award (STAR-19-0610). Dr. Johnson has been awarded a Canadian Institutes of Health Research New Investigator Award. Dr. Paula Rochon holds the RTOERO Chair in Geriatric Medicine at the University of Toronto. Dr. Lihi Eder has been awarded Early Researcher Award from the Ontario Ministry of Research, Innovation and Science and Canada Research Chair (Tier 2) in Inflammatory Rheumatic Diseases. Disclosure of Interests Sanjana Tarannum: None declared, Jessica Widdifield: None declared, Fangyun Wu: None declared, Sindhu Johnson: None declared, Paula Rochon: None declared, Lihi Eder Grant/research support from: UCB, Abbvie, Pfizer, Janssen, Novartis, Eli Lily, Sandoz Advisory board: Abbvie, Pfizer, Janssen, Novartis, Eli Lily